@layout("/common/_form.html",{js:["/assets/nanFeedback/nanFeedback_edit.js"],css:["/assets/common/module/formSelects/formSelects-v4.css"]}){

<form class="layui-form" id="nanFeedbackForm" lay-filter="nanFeedbackForm">
    <div class="layui-fluid" style="padding-bottom: 75px;">
        <div class="layui-card">
            <div class="layui-card-header">基本信息</div>
            <div class="layui-card-body">
                <div class="layui-form-item layui-row">
                    <input name="id" type="hidden"/>

                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label layui-form-required">用户ID</label>
                        <div class="layui-input-block">
                            <input id="userId" name="userId" placeholder="请输入用户ID" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label layui-form-required">运营组</label>
                        <div class="layui-input-block">
                            <input id="sellerId" name="sellerId" placeholder="请输入运营组" type="text" class="layui-input" lay-verify="required" required/>
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label ">问题描述</label>
                        <div class="layui-input-block">
                            <input id="question" name="question" placeholder="请输入问题描述" type="text" class="layui-input" />
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label ">社交账号</label>
                        <div class="layui-input-block">
                            <input id="socialMedia" name="socialMedia" placeholder="请输入社交账号" type="text" class="layui-input" />
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label ">订单号</label>
                        <div class="layui-input-block">
                            <input id="orderNum" name="orderNum" placeholder="请输入订单号" type="text" class="layui-input" />
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label ">邮箱</label>
                        <div class="layui-input-block">
                            <input id="email" name="email" placeholder="请输入邮箱" type="text" class="layui-input" />
                        </div>
                    </div>
                    <div class="layui-inline layui-col-md6">
                        <label class="layui-form-label ">状态</label>
                        <div class="layui-input-block">
                            <select name="status" lay-filter="status" >
                                <option value="">-请选择-</option>
                            </select>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
    <div class="form-group-bottom text-center">
        <button class="layui-btn" lay-filter="btnSubmit" lay-submit>&emsp;提交&emsp;</button>
        <button type="reset" class="layui-btn layui-btn-primary" id="cancel">&emsp;取消&emsp;</button>
    </div>

</form>

@}
